March 17, 2017

Who am I, Anyway?

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So many of our clients (and let’s be honest, ourselves as well) are eager to look inward and find out who they are.  For so many years, many of them have been labeled the “addict”, the “screw up” etc. and they don’t know who they are outside of those labels.  With that in mind, I often run a group that focuses on our roles within our family and with that, I love to bring in Caroline Myss’ archetypes.

When I first saw these Archetype cards in a grad school course, I immediately was hesitant because I could not get past thinking of them as Tarot cards which was not something I was personally going to bring into my sessions. However, these are far from Tarot cards, rather they are a list of archetypes that we can chose as being part of our personal support team and we chose based on how closely we associate with the light and shadow aspects of each archetype. Caroline Myss has written numerous books about archetypes and how individuals are made up of 12 archetypes, all of which are included in the box of archetype cards.

Of those 12 archetypes, we all share 4 “survival” archetypes that include; The Prostitute, The Saboteur, The Victim and The Child.  Once again, there are a variety of different child archetypes and it is again about finding the one that speaks most strongly to you and how you view yourself.

In terms of groups, I often give a brief background about each archetype (a book is included in each box of cards for reference) and I will then open it up to the group and allow them to go through the box and pick out archetypes that they identify within themselves.  This is a great exercise because each archetype has both “light” and “shadow” attributes and allows a greater discussion as to what strengths can come out of aspects of ourselves we often consider negative and vice versa.

An important note: for our clients that often get into black and white thinking, this exercise can be a challenge.  When I tell clients, “we all have the archetype of prostitute”, there is often push back and initial discomfort for that fact so it is important to be sure to follow that up with a conversation about the symbolism of prostitute.  An attribute of being the prostitute can be the negotiation of our own morals or ethics for financial gain; it is not necessarily saying that we all sell our bodies for financial gain.  With that in mind, it is important that you are well versed and educated in Caroline Myss’ theory and how it relates to archetypes before engaging in this exercises, but I would encourage others to give it a try! I have found it highly effective with men and women and individuals of all ages.

March 15, 2017

Soundtrack to Your Life

mix tapehttp://www.geekytechnews.com/wp-content/uploads/2012/07/7-80s-music-tapes.jpg

This blog started as a place to get some ideas for group and I intend to keep that goal going.  At my current agency, I continue to do groups, largely in the Substance Use field and as such, I have plenty of opportunities to fill our groups with psychoeducation but also with activities!

One activity I recently brought to the group was having all group members make a line on a piece of paper to represent their life.  Then, they were to place major life events on their timeline. After filling in their timeline with life events, they were to come up with a song that helped them identify with that moment.  As group members did this exercise, they were encouraged to play some of their music for the group (with the rule it could not be offensive).  This allowed for a more relaxed atmosphere and encouraged bonding between group members.

At the end of the group, members were encouraged to share what they felt comfortable sharing with other members of the group. They were encouraged to go home and create a playlist for the soundtrack of their life.

There are many variations you can do with this, for me, I encouraged clients to pick out the positive moments in their life to help identify songs and encouraged them to stay away from the negative moments.  Sometimes, we do the entire life, both positive and negative. Sometimes, you can do only future hopes and dreams and make it almost a dream board but through music.  No matter what you choose, it’s just helpful for them to get in touch with their emotions and thoughts in a different medium than just speech or writing which we tend to focus on in groups.

What do you all think? Any suggestions?

March 15, 2017

Back in the Thick of Things

Hi Everyone! I couldn’t believe when I opened my email and saw that my last blog post was TWO YEARS ago. In that time I have graduated my Master’s program, had my daughter, took a year off to be with her and began working at a new agency where I am officially an outpatient therapist (goodbye “intern” title!)

I had no idea how huge the change would be from intern to THERAPIST; foolishly I thought, “Hey, I was working full time hours between my job and internship, how much different could it be?” VERY different. For one, let’s talk caseload. I remember as an intern thinking I had a decent caseload with all TEN of my individual clients and a couple of groups.  Now, with a caseload over 6 times that amount and a number of groups, I look back on my intern self and can’t help but laugh.

However, something that I was surprised about was the change (or should I say lack of change) that I felt in myself.  During the first few months, I thought I had to bring every question to my supervisor as I was so accustomed to doing so as an intern. I remember going to my supervisor to discuss terminating a client and them saying to me, “Of course you may, you don’t need my permission”.

RIGHT. I’m a professional now.

This got me thinking.  Why didn’t I believe in my own abilities yet? I had the same educational background as my peers. I had a couple years in the field through internship and work, yet here I was, ACTING like a professional, but feeling like I was just playing make believe. It’s taken a few months of working to finally begin to feel like I am not posing as a therapist, rather that I am one that is practicing.

There’s always more to learn, but it’s important for us to be confident in ourselves with what we do know and to be OK with asking about all of those things that we don’t know quite yet.

 

August 27, 2015

When Saying Goodbye Really is the Hardest Part

When I learned of the news of my relocation, one of the very first thoughts I had was of immense sadness.  I was going to have to go through the brutal task of terminating with my clients.  These are clients who I have gotten to know over the past 2 years, many of them starting their journey in counseling at the same point in which I began my own. We have seen one another grow and progress in our respective lives.  The idea of not seeing them through to the end of treatment and not being able to ever know where they end up is difficult to process.  The counselor/client relationship is one that is so vastly unique than any other relationship.  No where else can you get to know someone so intimately and share such powerful moments while at the same time maintaining a professional boundary and let me tell you, sometimes that professional boundary is difficult to maintain.  I often find myself at home thinking about the various clients I see and wondering how better to assist them, where they are now, have they relapsed, are they engaged with counseling elsewhere. These thoughts are difficult to turn off and do not end once you walk out of the office doors, all that’s left is the hope they will succeed.  As a colleague once told me, “we plant the seeds, we just may not get to see them grow.”

October 10, 2014

Affirmation Stones

Working with substance use groups, you usually are talking about heavy topics and it is difficult to have clients focus on the positive aspects of themselves as opposed to dwelling on the negative ones.  In order to combat that, I have found affirmation stones to be a good group activity.  In terms of supplies, everything you need is simple!

1) MAGAZINES – try to get a variety – especially if you have a heterogeneous group. I like to have some Men’s Fitness, Self, People, etc. Try to steer clear from Cosmo unless you want some unnecessary moments of them getting stuck on the sex section and before you know it, an hour has gone by and everyone’s still wanting to talk about the “just right” orgasm.

2) Scissors – get at least one for every two people

3) Tape or Super glue – I tend to stay away from the super glue after some unfortunate mistakes, but it does look nicer than tape.

4) Stones – if you are at a location like mine, you can just walk outside and have them pick their own! Make sure it’s dry and clear from dirt before starting or it will be a gross mess.

After you have all of the supplies, encourage people to look for words or pictures that make them feel good about themselves and that highlight the good they have within themselves. Make sure that if you suspect there are any literacy issues with group members, to offer the picture idea as well.

The rocks serve a purpose other than as a fun activity for a group. When clients start to feel overwhelmed and find themselves in a downward spiral looking only at the negative things they have done and internalizing that as being bad people, they can look at their rocks to remember the positive.

Have you tried affirmation stones with clients before? How was the experience?

October 2, 2014

Finding Nemo and Substance Abuse?

Preparing for group this week, the topic was humor in recovery and I was at a loss as to what to do. Humor is absolutely essential for recovery; we take ourselves so seriously in recovery and are always focused on the bad that sometimes you need an outlet to just let loose and have fun.  With that in mind, I was stuck because how do I teach having fun? After consultation with colleagues, the decision was made to show a comedic movie, with certain guidelines. No violence, language, sex or alcohol/drugs. Having quite the extensive comedy collection in my house I was excited to the best one, excited until I began to look at my movies. After going through two rows of movies I realized the one thing all of my comedies had in common – DRUGS.  What is it about comedies that it necessitates the inclusion of drugs into the plot in order to increase the comedic value? I’m trying to help teach my clients that they don’t need drugs or alcohol to have fun, and here was every comedy I could find enforcing the exact opposite.

Second guessing my idea that this was going to be easy, I looked over to the section I was previously ignoring, my embarrassingly extensive Disney collection.  Now, for me, I can think of no better Friday night than coming home from work, having a nice dinner and then cozying up on the couch with my husband and dog and watching a Disney movie – they’re hilarious and make me feel good afterwards, but how was I going to convince a room full of clients the same thing? Throwing caution to the wind, I decided to give it a shot putting my full faith in the universality of Disney (while bringing some snacks to group hoping it would encourage a more positive experience).  I ended up settling on Finding Nemo because it’s a personal favorite and of course, there’s an AA scene in the film (Fish are Friends, Not Food!) so how could it not relate to the group!

My only fear in presenting a pixar movie was that the clients would feel like I was treating them like children.  Hoping to assuage this thought,  I introduced the movie by talking about how we take ourselves too seriously in recovery.  I spoke about when children have a difficult problem, they engage in play which allows them to creatively look at the alternatives and open up a world they may not have thought of. In recovery, we can do the same and sometimes engaging in play in a safe environment may assist them overcome scenarios they otherwise would not be able to do.  Happily, I can say that within a minute of presenting the movie idea to the group, they had already set up their chairs to the television and happily sat back allowing the movie to do it’s job. The room was filled with laughter and for 100 minutes, the stress and troubles in their lives were put on hold for fun.

Now, while I encourage everyone to show a movie like this to their clients in recovery, do keep in mind that at least some psycho-education should come after the movie. Questions to ask could include, how did you feel watching the movie? Did you expect to feel that way?

Also, if there is time, spend a little bit of time discussing the benefits of laughter on the body.  If you do not know the ways in which laughter can help the body, go to this site here for some information: http://www.discovery.com/tv-shows/curiosity/topics/10-reasons-why-laughing-good-for-you.htm

Alright, that’s all I have on showing a film like this in recovery. Go out and give it a try!

September 29, 2014

Post-Acute Withdrawal Syndrome (PAWS)

I remember when I was tasked with discussing PAWS with my clients and told that the topic would be covered over the span of two nights.  How am I possibly going to stretch this topic out to 6 hours??  Wrecked with self-doubt, I put my most creative energies to work and walked into the group still struggling with an idea on how to make this topic interesting.  As everyone was checking in I realized that I wasn’t really teaching them about PAWS, they were already experiencing it themselves, I was just opening their eyes to what was happening in their bodies!  With that in mind, I started group asking for everyone to talk about the differences they have felt in themselves while in recovery (excluding initial withdrawal symptoms) and within 15 minutes, they had compiled a list that included every symptom of PAWS.

Engaging the group in this way allows the clients to take ownership of their own learning. They didn’t need to be “taught” about the topic, they knew it and were just vocalizing it to the rest of the group. In addition, having the clients discuss their own symptoms in this way normalized the feelings that were happening in the room. No longer was it just one person who was having trouble with their memory, it was many.

Something I have found interesting was their fascination with the science behind PAWS. Often times when we are discussing a topic, the conversation will go back to the physiological reason behind the topic.  When discussing PAWS, it is important for you as the facilitator to be knowledgeable about the physiology behind it and for that I would suggest reading an oldie but a goodie, Stay Sober by Terence Gorski (excerpt can be found here).

Once you are finished discussing the many symptoms of PAWS, it is essential to have a discussion about managing symptoms. Gorski’s reading provides many talking points that should be included in the group discussion and one of the most important topics that should be covered is managing STRESS!!  

Speak to the group about the various ways we place more stress on our bodies and how we should work on being as LEAST stressed as possible during recovery.  Stress exacerbates the symptoms of PAWS. What are some ways to destress?

  • Cut out or limit the amount of caffeine intake! Human beings were not always caffeine dependent and today it seems we have taken caffeine consumption to a whole new level.  I remember when drinking caffeine to stay awake was when my mom would have her morning coffee.  Now that has turned into the morning coffee, and then 3 or 4 more other morning coffees thanks to the Keurig machines in every office. Don’t even get me started on Monster and Redbull!
  • Exercise!! It’s the word nobody wants to hear, but it is essential in managing stress.  Tired of the treadmill at the gym? Go outside!! Hiking can be done almost anywhere and it’s free so there’s really no excuse for avoiding it.
  • Watch a movie/tv.  Now, I’m not saying spend all of your free time in front of the television, but sometimes it’s essential to just unwind and watch something for pure entertainment, come on guys, “New Girl” is back and I know you are all wondering what’s going on with Nick and Jess…
  • Read a book.  I had to include this after I encouraged everyone to become zombies in front of the tv, but it works! Get lost in another world and become someone else for a change. If you’re stuck on what to read, Harry Potter is always getting into some great adventures and provides an excellent outlet for you to release the kid side of you for a few hundred pages.
  • Laugh with friends.  I’m not sure about you, but when I hang out with my friends I tend to be laughing at least 90% of the time.  Laughter is a natural destresser both physiologically and mentally so give it a try! Worst comes to worst, you will enjoy yourself anyway and have a much needed catch up session.
July 2, 2014

Design a TATTOO for Recovery!

Most of the clients who come through my facility have tattoos and lots of them. It is a rare day for us to get through a group session without them talking animatedly about either a tattoo that they already have or one they are planning on getting.  Therefore, when the topic for group one night was one that would be difficult to stretch to cover all two hours, I thought, why not have everyone design their own recovery tattoo?

Having clients design a tattoo that signifies their recovery allows them to become open and creative in different ways, ways they may not be able to do with their words alone.  Another benefit of this activity is that it allows clients to take it as deep or keep it as superficial as they feel comfortable. Some clients will probably make a joke of their tattoo and make it funny, whereas others may use symbolism to highlight their struggle with addiction. Regardless of what they choose to do, it is important to remember that your opinion as a counselor is not important.  However they choose to participate in this activity is up to the client. There is nothing more counter productive to therapy than a counselor who judges the client based on what they share in group.

Respect their experience and respect their ideas.

July 2, 2014

JENGA in Group Therapy!

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Alright, so it has been a while since my last post! I guess that’s what happens when you try to maintain a blog and balance everything else! Since my last post, I have continued to run groups at my site and have continued to bring new activities to the sessions.  One activity that has been a big hit each time I have used it has been JENGA therapy!  Now, when JENGA comes out, be prepared for there to be excitement and then a very quick reeling in of that excitement when you explain that it is therapeutic JENGA, but after they start playing, they will be so absorbed in the game that they won’t mind to be doing therapy at the same time.

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Wondering how to make therapeutic JENGA? There are many ideas out there, but I have found the numbering system is the best.  Some people write specific questions on each piece and when the piece is pulled, the client answers that question.  I, however, have found that writing the question on the piece limits what I can use therapeutic JENGA with in group.  Therefore, I have numbered each piece 1-8.  Then, depending on the session, each number will relate to a predetermined question based on the topic at hand.

For example, when the group topic is triggers, questions may look something like this:

1. What are your internal triggers?

2. What are your external triggers?

3. In what ways do you cope with triggers? (Name one)

4. In what ways do you hope to work with triggers? (Name one)

5. What thought stopping techniques do you know of? (Name one)

6. Name two strengths that you have.

7. Name one social support that you have in recovery.

8. Freebie (no question!)

 

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When the inevitable happens and the tower falls down, be sure to have one MEGA JENGA question prepared for such an event.  Sometimes, I have had that one be that the one who dropped the tower needs to compliment each client in the room. Other times, they have had to say 3 positive things they have in their life at this moment.  Either way, be sure that the question is different and one that warrants being the end of game question.

February 6, 2014

The Ungame

ungame

While I was looking for fun and exciting games to bring to my group therapy sessions, I kept coming across the Ungame. So, after weeks of hemming and hawing, I decided to give it a chance and bought it through Amazon.  Most of clients are in their 20s/30s so I bought the Ungame for 20 Somethings, hoping it would be less “hokey” and “family fun” and more geared to this age group.

Overall, it was a nice addition to the group because it was a break from our usual conversation based session. Clients were at first excited to play a game, but the problem was that this game doesn’t really feel like a game, rather it feels like you’re just going through a list of questions.

A few suggestions for the game:

  • Use deck 1 if you are utilizing the Ungame for a break from “formal” therapy. The questions are lighter and keep the conversation flowing and the clients connecting with one another without feeling like they need to share some deep, dark secrets.
  • Go through the cards! Some of the cards will be of no benefit to your particular group of clients so take them out.  Nothing kills the momentum of the game faster than pulling a card that takes everyone out of the moment.
  • Great game for clients who do not know each other too well – so try to use it on a newer group, or a group that recently added some new members.  It allows them to open up in an environment without any pressure. It is far easier to share your favorite movie than it is to talk about a relationship you ruined because of your drug use.  However, after connecting with others about something as minor as a favorite movie, the clients are laying the ground work for more deep and serious conversation later on.
  • Make it more of a game! Every other turn, I allowed the clients to either answer their question or give the question to someone else – the only rule was once they passed the question to another person, that other person could not be asked another question that round. Clients love this aspect and it brings more of a “game element” to the activity.

So go out and give the Ungame a try! If you have used the Ungame before or have any ideas on how to better incorporate it into therapy, let me know!